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20407 77TH AVE W
ITY 0 4t - 0 S) (o 3
CITY of EDMONDS BUSI S CENSE APPLICATION
Civic Center - Edmonds, Wash DATE
ington 980200,
City Clerk Phone 775-2525 STREET FILE TYPE OF BUSINESS
INSTRUCTIONS:
All items must be completed
or application will not.be ac-
cepted.
Sign and return application
with fee. Renewals received
aftdr February 15 must pay
NEW BUSINESSES AFTE
JULY-311, 1/2 FEE.
LICENSE NO.
ANNUALFEE
(A) HOME OCCUPATION $15.00
(B) BUSINESSWITH $20.00
1 TO 3 EMPLOYEES
0 (c) BUSINESSWITH $22.00
4 TO 9 EMPLOYEES
El (D) BUSINESS WITH 10 $75.00
OR MORE EMPLOYEES
EASE MAKE ANY NECESSARY CHANG
P<
NEW APPLICATION
0
RENEWAL
0
CHANGE
0
DELETE
AFTER FEB. 11
�2
4�50/
$ �3�
$ 1 2.50
(LA)
(LB)
(LC)
(LD)
NAME OF FIRM BUSINESS PHONE NO. OF EMPLOYEES
R/E C E I V E D
MAILING ADDRESS NATURE OF BUSINESS '71 1
cl C' IQ QfMCV458 FIRE DEPT.
BUSINESS ADDRESS INDIVIDUAL PARTNERSHIP CORPORATION
EZ (S) (P) (C)
OWNERS NAM� HOME ADDRESS
ARa=cw;;-_) Re I k /< .
AC)LI 0 _�- _� Ave CAJ - -)-I D Sy
HOMEPHONE DATE OF BIRTH PLACE OF BIRTH SOCIAL SECURITY NUMBER
_�_3_L1` �� '(�L( I �:�// 2-/4-/ �- I Nv'-6V,'V_\ I '��l (,:, - (�'2 -7 3 0 5
EMERGENCY NOTIFICATION (1) NAME& TELEPHONE
(PLEASE LIST TWO) (2) NAME & TELEPHONE
WASHINGTON STATE TAX NO.&keS RV APPLICANT'S SIGNATURE r
/ V
DO NOT WRITE BELOW THIS LINE If
STAFF REVIEW:. FILL IN LAND USE CODE, LIFIR NUMBERS, Z ' ONING, ETC. CHECK APPROVAL OR DISA�PROVAL, DATE, AND
SIGN. IF DISAPPROVAL, PLEASE COMPLETE "COMMENT" SECTION. ROUTE TO NEXT DEPARTMENT ON LIST.
PLANNING DEPARTMENT DATE LAND USE CODE ZONING CODE
�R XPPROVE 0 DISAPPROVE
SIGNATURE Pe Is F 161
CONDITIONAL USE PERMIT
COMMENTS
113U��DING DEPARTMENT DATE 9 Building 0 Hotel/Motel (L)
13"APPROVE 0 DISAPPROVE
SIGNATURE 14 Permit 0 Apt. Bldg. (A)
M I I I Cl Office Bldg. (0)
Occupancy 0 Restaurant (R)
COMMENTS: Group 0 Hosp/Nurs Home (H)
CAPACITY: (NO. UNITS, APTS. OFFICES, SEATS, BEDS, STUDENTS) 0 School (S)
FIRE DEPARTMENT DATE Y-l(b- U. F. R.
kAPPROVE 0 DISAPPROVE SIGNATURE. f-�)l a I
COMMENTS:
PO�PCE DEPARTMENT
DATE SIGNATURE
PPROVE 0 DISAPPROVE
COMMENTS:
P�BLIC WORKS DEPARTMENT
�1 APPROVE 0 DISAPPROVE DATE SIGNATURE
COMMENTS:
01 CACC 0Er-r11MK1 *Irt% t-l-rw r-i r-r-iiz
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds,, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the -map(s), in cluding, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employee-s or officers sh-all be liabl-e for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
CITY OF EDMONDS
Can PRospea 6-1107 when work
CIVIC CENTER —WATER-SEWER DEPARTMENT is ready for InspecUon. (No Mspee-
tions Saturday, Sunday ur holldays.) N2 1780
SIDE SEWER PERMIT
ADDRESS --------------------- ----- . ...... 20407 - 77th Avenue West
............................................................................ ........................................................................................
OWNER --------- Raymond --- G� --- Johnson .................................... CONTRACTOR --------- OWXler ............................. . ..........................
Permission is granted --- - ----- Karcla --- 1.4, -------------- P 19 ... 67, for ...................... days, to REPAIR or CONNECT a side sewer
with City Sewers in accordance with application on file and governing ordinances.
ATTENTION IS CALLED TO THE FOLLOWING:
NOTE No. 1—The owners of the property may obtain a permit to construct sewer Inside property line. A licensed Side Sewer Contractor must
be employed to construct side sewer in street area. Do not cover any portion of sewer before it has been inspected.
-TE No. 2--Obtain full Information regarding Ordinance 11.16.030 and Regulations governing side sewers when you get permit.
'r-TOTE No. 3--Top of side sewer must have at least 30 inches coverage at property line and 12 inches inside property line; minimum grade of 2%.
No bends in grade sharper than % will be permitted.
NOTE No. 4—Trenches in street must be water settled and surface of street restored to original condition. Contractors shall be responsible for
failure due to improper work which may develop within one year of completion.
NOTE No. 5—It is unlawful to alter or do any other work than Is provided for in the permit, or to do any work on the main sewer or Its ap-
purtenances except to Insert the pipe into the wye.
SIDE SEWER-q;-'!:-_
The City of Edmonds ie"TtREE-T FILE
NEW CONSTRUCTION El EASEMEN�
PS-05000
OWNER ..... ......... �--7 ........ ........ ............. CONTRACTOR .............................
ZA7 1) -
......... .............. PER�6 No.
. ................
ADDRESS ....... ........ ....... ......... LEGAL DESCRIPTION: LOT No. ............. Af Y .......................... BLOCK No..... .................
...................
NAME OF ADDITION .................................
. ... .............................................
q CG j
a -S
11 G C�u Pl
... .........